• Clinical Program Senior Advisor - Express Scripts…

    The Cigna Group (Morris Plains, NJ)
    …by the client + Develop, prepare, and present clinical business strategies (formulary, utilization and/or health management strategy, support for client P&T ... requires the combination of a strong clinical background, deep understanding of utilization management criteria, and ability to read pharmaceutical contracts,… more
    The Cigna Group (11/13/25)
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  • Medical Director Aetna Duals Center of Excellence

    CVS Health (Trenton, NJ)
    …state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor ... and New Jersey** offering a variety of physical and behavioral health programs and services to its...can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will… more
    CVS Health (11/13/25)
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  • Clinical Program Advisor/Program Management…

    The Cigna Group (Morris Plains, NJ)
    …existing clients with close attention to detail and accuracy + Review custom Utilization Management policies for rebate eligibility or adherence to contract ... in close partnership with business partners + Support standard utilization management review as needed + Create...-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k)… more
    The Cigna Group (11/15/25)
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  • Case Manager, Registered Nurse - Fully Remote

    CVS Health (Trenton, NJ)
    …. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience.… more
    CVS Health (11/19/25)
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  • Regional Director - Youth/IDD

    SERV Behavioral Health System (Hamilton, NJ)
    …regional program sites as needed. REQUIRED LICENSES/EXPERIENCE: + Master's degree in behavioral health discipline from an accredited school. + Clinical license ... BCBA, LCSW, LSW, etc.) preferred. + Minimum of seven years' experience in behavioral health , developmental disabilities, or human services with at least five… more
    SERV Behavioral Health System (11/06/25)
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  • Disease Management Nurse - Remote

    Sharecare (Trenton, NJ)
    …members to become empowered and active participants in their own healthcare management for their chronic condition. By providing health education and ... **Job Description:** Sharecare is the leading digital health company that helps people - no matter...nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management… more
    Sharecare (10/22/25)
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  • LTSS Service Coordinator - RN

    Elevance Health (Woodbridge, NJ)
    …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate… more
    Elevance Health (09/13/25)
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  • Inpatient Care Manager (RN)- Per-Diem, Days,…

    Atlantic Health System (Summit, NJ)
    …an Advanced Comprehensive Stroke Center. Additional Joint Commission-certified services include behavioral health care, spine surgery, wound care, and primary ... of selected member populations across the continuum of illness. Ensures effective utilization and monitors health care resources. Manages the interdisciplinary… more
    Atlantic Health System (10/01/25)
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  • Pharmacy Product Director - Medicare DSNP

    Highmark Health (Trenton, NJ)
    …of internal clinical and value-based evaluation committees that drive formulary and utilization management functions. + Participate in product specific Pharmacy ... value of implemented initiatives. + Lead product based pharmacy trend management discussions with internal partners including senior executives. + Support… more
    Highmark Health (11/14/25)
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  • Dental Network Service Representative

    Highmark Health (Trenton, NJ)
    …terms through regular on-site audits. Apply an active role in network management , training, monitoring and enforcement of company policies and procedures while ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
    Highmark Health (11/14/25)
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